Medical Surgical Diabetes #16

Question

The nurse is caring for a client with Type 1 diabetes. The client is on Sliding Scale Regular insulin subcutaneous before meals and at bedtime. The sliding scale is as follows:
-60 mg/dL – 150 mg/dL, give no insulin
-151 mg/dL – 200 mg/dL, give 2 units Humulin R
-201 mg/dL – 250 mg/dL, give 4 units Humulin R
-251 mg/dL – 300 mg/dL, give 6 units Humulin R
-over 301 mg/dL, give 8 units Humulin R and notify the physician

The bedside blood glucose is 210 mg/dL at 0730. How much insulin would the nurse give?

1. 4 Units Humulin N subcutaneous
• Rationale:

This answer is not correct because 4 units of Humulin N is not correct because Humulin R is ordered and Humulin N would not treat the blood glucose quickly enough. Also, 4 units is the correct amount but not correct because if incorrectly treated with Humulin N, the client would not have their 210 mg/dL, a high blood glucose, adequately treated.

2. 2 Units Humulin R subcutaneous
• Rationale:

This answer is not correct because 2 units of Humulin R is not the correct amount of insulin for 210 mg/dL. Two units of Humulin R treats blood glucose levels of 151-200 mg/dL so the client would still have increased blood glucose. The amount of 4 units of Humulin R is appropriate for a blood glucose range of 201-259 mg/dL and the client’s current blood glucose is 201 mg/dL

3. 4 Units Humulin R subcutaneous
• Rationale:

This answer is correct because 4 units of Humulin R is appropriate for a blood glucose range of 201-259 mg/dL and the client’s current blood glucose is 201 mg/dL More insulin could cause hypoglycemia and less insulin will not adequately treat the current blood glucose.

4. 8 Units Humulin R subcutaneous
• Rationale:

This answer is not correct because 8 units of Humulin R is not the correct amount of insulin for 210 mg/dL. Eight units of Humulin R is too much insulin and treats blood glucose levels of over 301 mg/dL so the client would be at risk of hypoglycemia. The amount of 4 units of Humulin R is appropriate for a blood glucose range of 201-259 mg/dL and the client’s current blood glucose is 201 mg/dL

Overview

Sliding scale insulin is solely determined by the client’s immediate blood glucose. It is not a scheduled insulin, where a client gets a consistent dosage of insulin (unless contraindicated).

Learning Outcomes

Sliding scale insulin is insulin given based on the client’s current blood glucose. The health care provider prescribes the insulin in specific amounts, depending on certain predetermined ranges. This method of administration helps to keep a tight control on blood glucose levels. It may be used with scheduled insulin or not. There are also provisions for when blood glucose is low and when blood glucoses are extremely high. It is a type of protocol written by the healthcare provider so that variations in blood glucose can be efficiently addressed without the need to contact the provider, unless extremes occur and it is necessary to contact the health care provider.

Test Taking Tip

Sliding scale insulin is as easy as reading directions. Be careful to check and double check the insulin level and amount prescribed. This could be a matter of life or death.